Myasthenia Gravis

Myasthenia gravis is a chronic autoimmune neuromuscular disease characterized by fatigue and varying degrees of episodic weakness of the voluntary muscles. The hallmark of myasthenia gravis is muscle weakness that increases during periods of activity and improves after periods of rest. Facial muscles and those involved in chewing, talking, and swallowing are often, but not always, involved. The muscles that that control breathing and neck and limb movements may also be affected.

Myasthenia gravis is caused by a defect in the transmission of nerve impulses to muscles. Normally when impulses travel down the nerve, the nerve endings release a neurotransmitter substance called acetylcholine. In myasthenia gravis, antibodies produced by the body’s own immune system block, alter, or destroy the receptors for acetylcholine. The first noticeable symptoms of myasthenia gravis may be weakness of the eye muscles, difficulty in swallowing, or slurred speech.

The onset of the disease involves only eye symptoms in 40% of patients, is generalized in 40%, and affects only the extremities in 10% (muscles close to joints are more severely affected than those further away). As the disease progresses, the weakness often spreads over the entire body. After the first year with myasthenia gravis, almost all patients have eye involvement, and in cases where the disease is destined to become generalized 90% will have become so involved. In 16% of patients only the eyes will ever be involved. During the first three years the progression of the disease is rapid and most deaths occur during this time. Myasthenia gravis occurs at all ages, usually between the ages of 20 and 40. If thymoma is associated, older men are more commonly affected.

Symptoms vary in type and severity. Myasthenia gravis is not directly inherited nor is it contagious. Onset is usually slow, but the disorder is sometimes unmasked by a coincidental infection that leads to a worsening of symptoms. Exacerbations may also occur before the menstrual period and during or shortly after pregnancy. Several diagnostic tests are available to confirm the diagnosis, including a special blood test that can detect the presence of immune molecules or acetylcholine receptor antibodies.

With conventional treatment, the outlook for most patients with myasthenia is bright: they can expect to lead nearly normal lives. Some cases of myasthenia gravis may go into remission temporarily, and muscle weakness may disappear so that medications can be discontinued. In a few cases, the severe weakness of myasthenia gravis may cause respiratory failure, which requires immediate emergency medical care.

 


Signs, symptoms & indicators of Myasthenia Gravis

Lab Values - Cells  

Low lymphocyte count



Symptoms - Aging  

Poor balance



Symptoms - Environment  

Poor tolerance of cold



 

Poor tolerance of heat



Symptoms - Gas-Int - General  

Difficulty swallowing



Counter Indicators
Symptoms - Gas-Int - General  

No difficulty swallowing



Symptoms - General  

Fatigue that worsens during the day



 

Constant fatigue



Symptoms - Head - Mouth/Oral  

Voice change



Symptoms - Muscular  

Individual weak muscles



 

Poor muscle tone



Counter Indicators
Symptoms - Muscular  

No individual weak muscles



Symptoms - Respiratory  

(Possible) difficulty breathing




Conditions that suggest Myasthenia Gravis

Circulation  


Symptoms - Muscular  

(Suspected) myasthenia gravis



Counter Indicators
Symptoms - Muscular  

Absence of myasthenia gravis




Risk factors for Myasthenia Gravis

Autoimmune  


Symptoms - Head - Eyes/Ocular  

(Possibly) drooping eyelid or drooping eyelids

In one-half to one-third of all patients, the first symptoms of MG involve the muscles in the eye. These include ptosis, which is a drooping of the eyelid, and diplopia, or double vision. These symptoms often increase toward the end of the day after a person has used their eyes for a long period of time. Usually, patients who have these symptoms develop both ptosis and diplopia within a couple of years. About 10% of all patients experience only these kinds of ocular (eye) problems, in which case their MG is referred to specifically as ocular MG. Most patients whose first symptoms are ocular eventually develop muscular weakness symptoms within a couple of years.



 

(Occasional/frequent) diplopia

The muscles of the eyelids and eye itself are generally affected earliest in the course of Myasthenia Gravis. Weakness occurs when the nerve impulse does not adequately reach the muscle cells. Eyelid droop and double-vision often result.



Counter Indicators
Symptoms - Head - Eyes/Ocular  

Absence of diplopia

The muscles of the eyelids and eye itself are generally affected earliest in the course of Myasthenia Gravis. Weakness occurs when the nerve impulse does not adequately reach the muscle cells. Eyelid droop and double-vision often result.



 

Absense of eyelid drooping

In one-half to one-third of all patients, the first symptoms of MG involve the muscles in the eye. These include ptosis, which is a drooping of the eyelid, and diplopia, or double vision. These symptoms often increase toward the end of the day after a person has used their eyes for a long period of time. Usually, patients who have these symptoms develop both ptosis and diplopia within a couple of years. About 10% of all patients experience only these kinds of ocular (eye) problems, in which case their MG is referred to specifically as ocular MG. Most patients whose first symptoms are ocular eventually develop muscular weakness symptoms within a couple of years.



Tumors, Benign  

Thymoma

About 15% of patients with myasthenia gravis are found to have a tumor of the thymus gland, known as a thymoma. Most thymomas are benign.




Recommendations for Myasthenia Gravis

Diet  

Raw Food Diet

The raw food diet (RFD) has generally produced improvement and even possibly cured MG. The use of fresh vegetable juices can help increase the percentage of raw foods consumed.



 

Gluten-free Diet

Autoimmune diseases in general have a higher prevalence of gluten intolerance. A one-month trial period of avoiding dairy products and foods containing gluten/gliadin should indicate whether there is going to be any change in symptoms or lab values in individual patients. If there are improvements then these foods will need to be avoided on a permanent basis.



 

Dairy Products Avoidance

See discussion of Myasthenia Gravis and Gluten-free Diet.



Drug  

Conventional Drugs / Information

Conventional medicine can control myasthenia gravis. Some medications improve neuromuscular transmission and increase muscle strength, and some suppress the production of abnormal antibodies. These medications must be used with careful medical supervision because they may cause major side effects.



Habits  

Tobacco Avoidance

Dr. Fred Klenner, MD claims that patients with myasthenia gravis will hinder their progress if they use tobacco.



 

Aerobic Exercise

Available literature indicates that patients with myasthenia gravis may benefit from both a strengthening as well as an aerobic/cardiovascular fitness program. Patients should be taught a home exercise program that is individualized for their limitations and tolerance. Physical training is safe for patients with mild myasthenia gravis and does produce some improvement in overall muscle strength.

Walking for short periods at a slow pace is a good way to start a walking program. Increase the exercise time slowly until you build up to 30 minutes of continuous walking. If you are comfortable with this, then your speed can slowly be increased. Before beginning any exercise program, please check with your doctor for advice on whether this is appropriate for you, and what form of exercise is preferred.



Lab Tests/Rule-Outs  

Tests, General Diagnostic

A special blood test can detect the presence of immune molecules or acetylcholine receptor antibodies. Most patients with myasthenia gravis have abnormally elevated levels of these antibodies. However, antibodies may not be detected in patients with only ocular forms of the disease.

Another test is called the edrophonium test. This approach requires the intravenous administration of edrophonium chloride or Tensilon(r), a drug that blocks the degradation (breakdown) of acetylcholine and temporarily increases the levels of acetylcholine at the neuromuscular junction. In people with myasthenia gravis involving the eye muscles, edrophonium chloride will briefly relieve weakness. Other methods to confirm the diagnosis include a version of nerve conduction study which tests for specific muscle “fatigue” by repetitive nerve stimulation. This test records weakening muscle responses when the nerves are repetitively stimulated. Repetitive stimulation of a nerve during a nerve conduction study may demonstrate decrements of the muscle action potential due to impaired nerve-to-muscle transmission.

A different test called single fiber electromyography (EMG), in which single muscle fibers are stimulated by electrical impulses, can also detect impaired nerve-to-muscle transmission. EMG measures the electrical potential of muscle cells. Muscle fibers in myasthenia gravis, as well as other neuromuscular disorders, do not respond as well to repeated electrical stimulation compared to muscles from normal individuals. Computed tomography (CT) may be used to identify an abnormal thymus gland or the presence of a thymoma.

A special examination called pulmonary function testing – which measures breathing strength – helps to predict whether respiration may fail and lead to a myasthenic crisis.



 

Hydrochloric Acid (Trial)

Stomach acid levels are generally lower in patients with autoimmune diseases. Inadequate digestion can add to the immune system malfunction.



 

Test for DHEA

DHEA is almost always low in patients with autoimmune conditions such as myasthenia gravis.



Mineral  

Potassium

The weakness of myasthenia gravis may be improved by potassium consumption, if dietary potassium is low.



 

Manganese

Manganese deficiency has been linked to myasthenia gravis. Manganese activates several enzyme systems and supports the utilization of vitamin C, E, choline, and other B-vitamins. Inadequate choline utilization reduces acetylcholine synthesis, contributing to conditions such as myasthenia gravis. Please also see the link between MG and Vitamin E.

Grass juices from mineral-rich soil are high in manganese.

Removal of the thymus gland is widely practiced as long-term therapy for MG. Most patients improve for a period and some may continue improving, while others soon deteriorate again. There was an old report suggesting the complete failure of nutritional and manganese therapy in MG patients who had their thymus removed. [E. M. Josephson, Thymus, Manganese, and Myasthenia Gravis 1961]



 

Magnesium

While magnesium is an important mineral and magnesium deficiency is somewhat common, a large dose of a magnesium may act as a muscle relaxant and cause extreme weakness in MG.



Nutrient  

Essential Fatty Acids

Essential fatty acids have been shown to suppress autoimmune attacks in general and to help protect myelin sheaths. A blend of omega-3 and omega-6 fatty acids may provide supportive benefit in the treatment of myasthenia gravis



Physical Medicine  

Rest

Sufferers should get plenty of rest and adjust their activities to avoid unnecessary fatigue. This may include resting frequently as necessary during the day.



Psychological  

Stress Management

Emotional stress, excessive heat and cold, fever, and exposure to infections can worsen symptoms and should be avoided whenever possible.



Surgery/Invasive  

Surgery

The thymus is thought to play an important role in the development of the disease by supplying helper T cells sensitized against thymic nicotinic receptors. In most patients with myasthenia gravis, the thymus is enlarged, and 10-15% have thymomas. Thymectomy is indicated if a thymoma is suspected. In patients with generalized myasthenia without thymoma, thymectomy induces remission in 35% and improves symptoms in another 45%.

The thymus is the master gland of immunity, and removing this gland weakens the body’s ability to fight infections and cancer. The thymus normally shrinks and becomes less useful with age. It would seem logical that thymectomy in a younger person could have greater negative long term consequences than thymectomy in an older person.

Some researchers believe that the variability of thymectomy outcomes is due to other pockets of thymus tissue that may be present in the neck area, which are not removed during surgery. These will often be sufficient to maintain a reasonable manganese metabolism and, with this, enable an eventual recovery. On the other hand, if all thymus tissue has been removed, then a full recovery may not be possible with nutritional means.



Vitamins  

Vitamin B Complex

The main B vitamins are essential for energy production in the muscles, and some improvement in MG can be expected with B-complex supplementation. This effect may result in a lowered requirement for enzyme-blocking drugs, if used.



 

Vitamin B12 (Cobalamine)

To enhance acetylcholine levels take vitamin B12 1000mcg sublingually each day.



 

Vitamin E

Vitamin E is directly involved with the energy metabolism of muscles. A deficiency causes increased amounts of muscle protein to break down and be expelled with the urine as as is the case with MG. The importance of vitamin E in MG can be seen in cases where the initial use of other vitamins improved the condition somewhat, but only after the addition of vitamin E did all symptoms of the disease disappear [E. M. Josephson, Thymus, Manganese, and Myasthenia Gravis 1961]. Also, MG may resurface after a year or two and then vitamin E is no longer effective unless manganese is supplemented in addition.

The various vitamins suggested for this condition have been used successfully in megadose quantities [F.R. Klenner, J. Appl. Nutr. 1973; 25: 16.]. Although helpful, these vitamins alone are often not sufficient for a permanent cure.



 

Vitamin B5 (Pantothenic Acid)

To enhance acetylcholine levels take pantothenic acid 100mg daily. There is sufficient evidence to believe that coenzyme A, which is the physiologically active form of pantothenic acid in animals, is in limited supply in cases of myasthenia gravis.



 

Vitamin B1 (Thiamine)

To enhance acetylcholine levels take thiamine 100mg daily. Additionally, Dr Fred Klenner, MD stresses the importance of thiamin in treating myasthenia gravis and recommends its use by injection. From 30 years of experimentation he concludes that this is not a vitamin deficiency disease but one of several vitamin-dependent diseases, where the successful treatment requires dosages up to 1,000 times the minimal daily requirement that has been established for thiamin.



Key

Weak or unproven link
Strong or generally accepted link
Proven definite or direct link
Weakly counter-indicative
Strongly counter-indicative
Very strongly or absolutely counter-indicative
Likely to help
Highly recommended
May have adverse consequences

Glossary

Chronic

Usually Chronic illness: Illness extending over a long period of time.

Autoimmune Disease

One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.

Neurotransmitters

Chemicals in the brain that aid in the transmission of nerve impulses. Various Neurotransmitters are responsible for different functions including controlling mood and muscle movement and inhibiting or causing the sensation of pain.

Acetylcholine

A neurotransmitter widely distributed in body tissues with a primary function of mediating synaptic activity of the nervous system and skeletal muscles.

Antibody

A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.

Immune System

A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.

Thymoma

A tumor of the thymus, an organ that is part of the lymphatic system and is located in the chest, behind the breastbone.

Milligram

(mg): 1/1,000 of a gram by weight.

Ptosis

A drooping of the eyelid(s).

Benign

Literally: innocent; not malignant. Often used to refer to cells that are not cancerous.

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